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Venepuncture

VOL: 98, ISSUE: 50, PAGE NO: 33

All nurses are likely to be responsible for the administration and management of some form of intravenous (IV) therapy. A brief overview of the main types and routes for this administration follows.

All nurses are likely to be responsible for the administration and management of some form of intravenous (IV) therapy. A brief overview of the main types and routes for this administration follows.

TYPES OF INFUSION
- Continuous infusion: generally large volumes of drug or solution given at a set rate over a prolonged period.

- Intermittent infusion: drugs such as antibiotics added to a small amount of solution (up to 500ml) and given over a short period, at a specific time or frequency.

- Bolus or direct injection: direct injection of a drug into the vascular access device or infusion port, given as a slow bolus or push.

VASCULAR ACCESS DEVICES
There are a number of vascular access devices which can be used for the administration of IV therapies. However, not all access devices are suitable for all types of infusion and the nurse has a responsibility to know which are and are not suitable in each case.

TYPES OF VAD
- Peripheral cannula: designed for short-term use (48-96 hours), inserted into the peripheral veins of the arm or foot.

- Midline catheters: designed for short to medium-term access, inserted peripherally up to 20cm into the vein, often used when peripheral access is difficult or limited. They protect the integrity of veins.

- Peripherally inserted central catheter (PICC) lines: designed for long-term use (several weeks or months), inserted peripherally and advanced into central veins. Often used for total parenteral nutrition.

- Percutaneous central venous catheter (CVC): short to medium-term use, inserted through the skin via the internal jugular or subclavian vein, into the superior vena cava.

- Skin-tunnelled central-venous catheter (Hickman Line) - long-term, indefinite use, inserted to separate the entry to the vein from the skin opening. Tissue granulates around the cuff to create a tunnel, acting as a barrier to infection.

- Implanted ports: for long-term, continuous or frequent use.

- As well as using VADs some therapies can be administered subcutaneously.

MANAGEMENT CONSIDERATIONS
When using VADs:

- Keep the device free from infection using aseptic techniques;

- Ensure that all devices used in administration remain undamaged;

- Ensure that the administration is via a closed IV system, to reduce the risk of infection or malfunction;

- Maintain device patency.

In the administration of IV therapy the nurse also has a responsibility to ensure that:

- The patient is correctly identified and consents to the treatment;

- The prescription is verified - usually by a second nurse - and administered to the correct patient;

- The infusion device is free from fault or damage;

- The fluid is within its expiry date;

- Any problems with the access device or administration site are observed and reported;

- The infusion rate is calculated correctly and is delivered accurately;

- The patient's condition is monitored;

- All interventions are documented appropriately.

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